Talk:Cardiovascular System - Patent Ductus Arteriosus
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Cite this page: Hill, M.A. (2024, May 7) Embryology Cardiovascular System - Patent Ductus Arteriosus. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Cardiovascular_System_-_Patent_Ductus_Arteriosus |
2012
Ductal ligation in the very low-birth weight infant: simple anesthesia or extreme art?
Paediatr Anaesth. 2012 Jun;22(6):558-63. doi: 10.1111/j.1460-9592.2012.03846.x. Epub 2012 Apr 10.
Wolf AR. Source Paediatric Anaesthesia and Intensive Care, Bristol Royal Children's Hospital, Bristol, UK.
Abstract
Management of the very low-birth weight infant in the neonatal intensive care unit (NICU) is geared to provide optimal outcome not only in term of survival but increasingly with a goal of limitation of long-term neurological and pulmonary morbidities. Careful follow-up studies have demonstrated that relatively small variations in oxygenation and gas exchange, ventilator management, and other management modalities can have long-term consequences. Within this context, there are good data that closure of a clinically significant patent ductus arteriosus has outcome benefit, but little data on the idealized anesthetic to manage such fragile patients. Does the anesthetic management matter? Given the attention to detail within the NICU, it would seem prudent to try to choose techniques that limit changes in hemodynamics, gas exchange, and ventilation within the context of the surgery. Anesthesia for ductal ligation in the very low-birth weight infant may need to be judged by more than simple survival and brings into question the current techniques and monitoring used. © 2012 Blackwell Publishing Ltd.
PMID 22489639
2011
Treatment of patent ductus arteriosus with bidirectional flow in neonates
Early Hum Dev. 2011 May;87(5):381-4. Epub 2011 Mar 12.
Ethington PN, Smith PB, Katakam L, Goldberg RN, Cotten CM. Source Department of Pediatrics, Duke University, Durham, NC 27710, United States.
Abstract BACKGROUND: Patent ductus arteriosus is a common occurrence among prematurely born neonates and is believed to play a role in the development of other complications of prematurity including intraventricular hemorrhage, bronchopulmonary dysplasia, and necrotizing enterocolitis. The clinical decision to treat the patent ductus arteriosus is complicated by the lack of evidence available regarding clinical conditions under which closure should be attempted. STUDY AIMS: To compare clinical outcomes for neonates who underwent treatment of patent ductus arteriosus exhibiting bidirectional blood flow versus those with flow that was left to right. STUDY DESIGN: Cohort study of all neonates with patent ductus arteriosus in which medical closure was attempted at the Duke University between January 2002 and October 2007. OUTCOME MEASURES: Death and other important clinical conditions. RESULTS: We identified 20 neonates with bidirectional flow out of 317 cases in which medical closure of patent ductus arteriosus was attempted. There was no significant increase in overall complications due to closure of a bidirectional patent ductus arteriosus [40% (8/20)] versus ones with left to right shunting [38% (111/297) p=0.82]. Death occurred in 15% (3/20) with bidirectional PDA compared to 11% (34/297) in the left to right group, p=0.72. CONCLUSION: The trend in mortality is worrisome but does not contraindicate an aggressive approach to the clinically significant PDA that has bidirectional flow at the time of the echocardiogram. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
PMID 21402454
